Caring for Child w/ Resp. Condition Flashcards
-Narrow airway
-Nonproductive cough & little mucous
-Belly breathers til age 6
-Lymphoid tissues absent til age 7
-Epiglottis is long & flaccid til age 8
-Epiglottis is U-shaped
-Larynx & glottis is higher in the neck
-Thyroid/cricoid/tracheal cartilage are immature
-Neck has fewer muscles
Infant
-Rapid growth and expansion of alveoli
-Lung development complete by age 5/6
-Right bronchus shorter, wider, and more vertical
-Frontal and sphenoidal sinuses are developed
Toddler & school-age
What is the purpose of the eustachian tube?
-Reduces pressure
-Drains fluid from middle ear
More difficult to do these things in children because of shape (more horizontal than in adults)
Health history information to obtain during assessment
-allergies
-immunizations utd?
-number of colds/year (6-8 is typical)
Risk factors for respiratory distress
-congenital heart defects
-immunosuppression
-premature birth
-genetic disorders
-environmental (smokers, exposure to illness, daycare)
Health O2 saturation for healthy infants and children?
95-100%
Levels of resp. distress
mild, moderate, & severe
Sx of mild resp. distress
-tachypnea
-tachycardia
-diaphoresis
Sx of moderate resp. distress
-nasal flaring
-retractions
-grunting
-wheezing
-anxiety, irritability, & mood changes
-headaches
-hypertension
will still see mild sx
Sx of severe resp. distress
-bradycardia
-stupor, coma
-cyanosis
-apnea/ALTE
will still see mild and moderate sx
Mild retractions
intercostal
Moderate retractions
substernal and subcostal
Severe retractions
supraclavicular and suprasternal
Irregular breathing with pauses <20 seconds
Normal resp. variation
-Pauses lasting >20 seconds
-Associated with cyanosis, pallor, hypotonia, and bradycardia
-May be 1st major sign of distress in newborn
apnea
-Color change, limp tone, choking/gagging
-Usually seen in infants under 2 months
ALTE (acute life threatening event)
Causes of apnea/ALTE
reflux, lower airway disorders, seizures, trauma, sepsis, or pertussis
Management of apena/ALTE
physical stimulation, resuscitation, and treating underlying cause
Airway positioning for resp. distress
-avoid flexion
-do not hyperextend neck
-support shoulders w/ towel (sniffing position)
-upright position/elevate HOB
Types of O2 tools
-nasal cannulas
-face mask
-blow by
-humidification
-bi-pap
-mechanical ventilation
Malformation of the posterior choanae in the nose causing a blockage
-can be bone or membranous
-can be both sides or unilateral
choanal atresia
S/sx of choanal atresia
- Dyspnea
- Cyanosis at rest
- Difficulty eating (Choking, regurgitating food)
- Unilateral choanal atresia may be asymptomatic unless child is sick
How is choanal atresia diagnosed and treated?
Confirmed w/ CT
Surgical correction- transnasal or transpalatal w/ puncture or stenting
Bilateral requires emergency surgery
Failure of esophagus to develop continuous passage to stomach
* Blind pouch
Esophageal Atresia (AE)
Portion of esophagus is connected to the trachea by a fistula causing abnormal communication between the two structures
Tracheoesophogeal Fistula (TEF)
S/sx of AE & TEF
- Excess drooling/secretions
- Frothing/bubbling
- Cyanosis
- Choking with feeding
- Inability to pass OG/NGT
How is AE & TEF diagnosed and treated?
Confirmed w/ prenatal ultrasound (no barium)
Surgical emergency to close fistula and join sections
If preemie/compromised surgery will wait until stable
Barium can cause
defects and malformations
Autosomal recessive abnormality on chromosome 7 that impairs movement of Cl- and Na+ within the cells, thickening secretions. Most commonly the respiratory biliary, pancreatic, and intestinal tracts. Diagnosed using sweat chloride test.
Cystic fibrosis (CF)
What is the sweat chloride test: gold standard?
A mild electrical current pushes medicine into the skin causing sweating. Sweat is collected and salt content is measured.
Normal <40mEg/L
Suspicious 50-60mEg/L
Diagnostic >60mEg/L
Systems affected by CF
Sinuses: sinusitis (infection)
Lungs: thick, sticky mucous buildup, bacterial infection, and widened airways
Skin: sweat glands produce salty sweat
Liver: blocked biliary ducts
Pancreas: blocked pancreatic ducts
Intestines: cannot fully absorb nutrients
Reproductive organs: male & female complications
Airway w/ CF
-thick, sticky mucus blocks airway
-widened airway
-blood in mucus
-bacterial infection
Most common cause of death for CF pts?
lung damage is the most common cause of death
How to treat CF lung complications?
- Mucous plugs cause air trapping and atelectasis
- Chronic bacterial and fungal colonization progressively destroy lung tissue
- Lung damage most common cause of death
-Airway clearance: chest physiotherapy and vests
-“Asthma” Medications + Pulmozyme (thins secretions)
-Yearly Tune-ups at the hospital
-Minimize exposure to illness
-CF patients should be separated by at least 6 feet from others with CF
-Exercise/Fitness
How to treat CF digestion complications?
- Clogging of pancreas ducts prevents pancreas from delivering digestive enzymes
- Malabsorption-especially fats and proteins (steatorrhea)
- Bowel obstruction due to thick mucous
- Pancreatic Enzymes with meals/snacks
- 110%-150% Calories with 35%-40% fat intake (increase calories and decrease fat)
- ADEK vitamins
How to treat CF skin complications?
- Sweat gland malfunction leads to excess sodium & chloride in sweat
Salt tablets-may need during summer/exercise
How to treat CF reproductive system complications?
- Small stature
- Delayed puberty
- Vas deferens in males affected 95% of males are infertile
- Dense vaginal and uterine mucus plugs may block sperm from being able to fertilize an egg (fertility issues)
- Genetic counseling
- Promote nutrition to encourage growth and development
Sore throat
Commonly caused by:
Viral 85% -Commonly Adenovirus
Bacterial 15-25%
Group A beta-hemolytic strep (GABHS)~15-25%
pharyngitis
S/sx of pharyngitis
Fever
Sore throat
Difficulty swallowing
Cervical adenopathy
Inflamed pharynx and tonsils
Abdominal pain
Important points of pt education for pharyngitis
Take antibiotics as prescribed! (for bacterial)
Tylenol/Ibuprofen
Change toothbrush to prevent re-infection
Return to school after 24 hours of antibiotics
What happens if antibiotics aren’t finished?
Bacteria will become resistant to antibiotic
Tonsils secrete immunoglobins. Strep is most common cause.
tonsillitis
- Can be viral OR bacterial
- Upper airway inflammation/swelling
- Affects larynx, trachea, and bronchi
- Edema/erythema of lateral walls of trachea below vocal cords
croup syndromes
- Viral etiology
- Peak 3-36 mos.
- URI
- Seal-bark cough, worse at night
Acute Laryngotracheitis
- Viral etiology
- Peak 3-36 mos.
- NO URI
- Sudden onset at night with barky cough
Spasmodic Croup
- Viral etiology
- More common older children
- Hoarseness
Laryngitis
Management of viral Croup
- Supportive care
Fluids, Pain management, Fever management, Cool mist vaporize, & Steroids - Can usually manage at home
Types of bacterial croup
bacterial tracheitis, epiglottis, & laryngotracheobronchitis
- Progressive illness over 2-5 days
- Complication of viral disease or prior URI
- Can lead to life-threatening airway obstruction
- High Fever >102.2
- Croupy cough
- Thick, purulent secretions
- Hoarseness
Bacterial Croup
- MOST Life-threatening
- droplet precautions
- Bacterial: H. Influenza, GABHS
- Peak 1-5y
- Rapid progression
- High Fever 101.8-104
- 4 D’s: Dysphonia, Dysphagia, Drooling, Distressed Resp Effort
- TRIPOD position
- Lateral neck x-ray will show a narrowed airway/round epiglottis- ”Thumb sign”
Epiglottis
- Bacterial: Staph A (can be viral too)
- Peak 3-36 mos.
- Acute onset
- High Fever 102.2
- Barky-seal cough
- Hoarseness
- Stridor and resp. distress
- Chest x-ray will show a ”Steeple Sign”
Laryngotracheobronchitis
Why should throat inspections/cultures be avoided in pts w/ epiglottis?
can cause spasms
- Direct contact w/secretions or contaminated surfaces
- Annual epidemics October-March
Low grade-Moderate Temp
URI/cough May be dehydrated
Severe resp. distress
Adventitious lung sounds
Usually resolves 5-7 days
BRONCHIOLITIS/RSV
(Resp. Syncytial Virus)
Infection of the pulmonary parenchyma (alveoli)
- Retractions, nasal flaring, malaise, chest pain, poor appetite, adventitious or diminished sounds, abdominal distention & pain
- Viral: Usually symptoms less severe
- Bacterial: cough, dyspnea, tachypnea, adventitious breath sounds, grunting, retractions, toxic appearance
- Mycoplasma: Common in pts with asthma
Pneumonia
- Highly contagious lung infection caused Bordatella Pertussis
- Can be DEADLY to infants
- Highest risk < 3 months
- Signs and symptoms based on 3 stages
PERTUSSIS
(WHOOPING COUGH)
Stages and sx of Pertussis
- Catarrhal Stage- Lasts 1-2 weeks: URI-Mild cough, coryza,
and sneezing, low-grade fever < 101°F - Paroxysmal Stage- Lasts 2-4 weeks: paroxysmal cough ending w/inspiratory whoop,
- Convalescent StageLasts 3 weeks-6 months: Cough less severe-whoops slowly disappear.
Caused by any damage to the lungs- sepsis, viral pneumonia, smoke inhalation, drowning, or aspiration
Acute Respiratory Distress Syndrome (ARDS)
How to prevent VAP (ventilator acquired pneumonia)
-Prevention bundle care if ventilated which includes mouth care, suctioning, HOB elevated, not dumping condensation into ventilator circuit
Lung/bronchiole inflammation caused by a trigger that activates IgE antibodies
* Causes the airway to swell and mucus trapping
Asthma
Asthma triggers
- Environmental
- Viral illnesses
- Allergens
- BPD (bronchopulmonary dysplasia)
- Misc: fragrances, exercise, emotions, weather changes
Severe s/sx of foreign body aspiration
cyanosis, drooling, dyspnea, forceful coughing, stridor, wheezing
Blockage of the respiratory passage with either fluid or solid matter
Most common in toddlers
Severity depends on size of object and angle of placement inside the
passage
Foreign body aspiration
Smoke inhalation requires
(Inhalation of smoke that is a mixture of gas and aerosolized matter)
emergency treatment that consists of stabilizing the airway and flushing excess CO2
